THE APPLICATION PROCESS PRAY Is this what you would have me do this year, God? Where do You want to use me this summer? How do You want to grow me? Am I prepared to invest a considerable amount of my time into this mission over the next spring and summer? Am I prepared to sacrifice things, if necessary, to prepare for and grow through this journey?
READ The instructions: Carefully read so you don’t miss any pieces. The details: Search out all details and dates of each journey you are considering to ensure you can attend all meetings. The requirements: Know what you are committing to this season and allow God to prepare you for it . . . and get you excited and ready to grow! Don’t forget the Personal Reference/Parent Reference/Agreement Form, too.
SUBMIT Application Day: Sunday, January 22 Have I committed to praying about this opportunity? Do I understand the expectations of this commitment? Am I ready to answer the call to serve in the Kingdom? Yes? AWESOME! Submit an app to The Road on Application Day. Teams are formed prayerfullly and in consideration of what is most beneficial to: o You o The team o The mission/ministry Thanks for praying with us! Teams will be posted online Sunday, February 5 at 5pm!
Application Checklist
Name: Office Use Only
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8th Grade
I have included this
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Application with all questions fully answered Commitment Declaration and signed Mission Journey Agreement Completed Parent Reference Form Copy of Insurance Card Photo (wallet size or larger) $100 Deposit Check made out to Faithbridge
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*Please include your student’s name in the memo line
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Over-the-Counter Medication Authorization Road Medical Release & Waiver for the Journey Online Personal Reference Form* Teacher Reference (first-time applicants only)* *Due by: January 22, cannot be FSM/Road staff
I asked the following person(s) to complete the online reference form: Their phone number is: Their phone number is:
I confirm that I have included all of the items above.
Student Signature Above
For all questions and/or concerns prior to Application Day on January 22th, please call or email the Road office! THE ROAD 281-320-7588 ext. 135
[email protected]
Office Use Only I confirm that all of the items above have been received. ________________________________________________________________ Print Name Above
Journey List Name
Current Grade Please rank Journeys with a 1, 2, 3, etc., 1 being your first choice, 2 being your second choice, and so on. Place an “X” next to the Journey(s) you are NOT able to go on. Please do not leave any Journeys unmarked.
COST $700
RANK _______
JOURNEY Lubbock 1
DATES June 25 – July 1
_______
Lubbock 2
July 2 - 8
_______
Lubbock 3
July 9 - 15
_______
Lubbock 4
July 16 - 22
_______
Lubbock 5
July 23 – 29
EXAMPLE 1 Journey 1 July 6-15 X Journey 2 July 17-26 2 Journey 3 June 22-July 5
MANDATORY SUNDAY TRAININGS 2/19, 4/9, 5/7 2/19, 4/9, 5/7 2/19, 4/9, 5/7 2/19, 4/9, 5/7 2/19, 4/9, 5/7
In addition to your mandatory Sunday team meetings, you and your parents will also need to attend the Journey Orientation, Final Meeting, and Missions Send Off. Please refer to the last page of this packet for those dates. Please provide a brief explanation (dates, cost, etc.) for the Journeys you are NOT able to attend.
Contact Information Full Legal Name Last:
First:
Middle:
Name you go by: Birthdate:
Grade: /
/
Gender:
Student Cell:
Male
Female
Estimated T-Shirt Size in May:
Student Email: Permanent (Home/Parent) Address
Primary Parent E-mail to Receive Communication: Primary Parent Phone Number for Phone Tree & Communication: Dad’s Name:
Mom’s Name:
Dad’s Cell:
Mom’s Cell:
I would like to receive email opportunities about volunteering with the Road throughout the season (sorting, Gear Shop, driver needs, etc.). _______ Yes, please send messages to this email: _______ No, thanks Do you have any family members who are also applying for a Mission Journey? If so, please list their name (and GRADE, if applicable). Name(s):
Grade(s):
Tape Student Photo Here (wallet size or larger – photo will not be returned)
Student Questions Please complete the following questions, answering them as honestly as you can, so we can get to know the real you and form teams according to what is most beneficial to you! 1. Do you have a personal relationship with Jesus? If your answer is “No,” please skip to #6 on the next page understanding that a “no” answer does not disqualify you from a mission journey with us! 2. What has led you to put your faith in Christ? Tell your story.
3. What is the good news of the Gospel?
Through what struggles of your own do you experience that good news? In what ways and words do you share that with others?
4. What is a mission journey to you, and why do you desire to go?
5. What has God been teaching you or doing in your life lately? Explain.
6. What are your 3 greatest strengths and weaknesses?
7. What are you passionate about? What do you love to be doing?
8. How do you usually react in situations where you are uncomfortable or unsure?
9. How do you hope to grow through/on a mission journey?
10. Are there areas you have served at Faithbridge, in the community, or at your school over the last six months? If so, please list.
11. What outlets for growth have you been utilizing in the recent months (e.g. Curious, Elevate, discipleship, another church, school groups, Bible studies, etc.)?
12. What other mission journeys have you been on, if any?
COMMITMENT DECLARATION By signing this page and the Mission Journey Agreement, our heart is that you would experience the absolute most God has for you on your Mission Journey. Missing training dates means less time growing as a team. We want you to experience God through close-knit relationships within your team, which ultimately serve to support our ministry partners at each site. Like any other sport, club, band, or activity, there is responsibility and sacrifice involved in maintaining this commitment, but that’s because it’s something worthwhile. We don’t want you missing out on any of those opportunities! Can you commit to attend the mandatory scheduled training meetings for the journeys to which you are applying? Meetings: Students and parents attend Journey Orientation: Sunday, February 12, 2-3:30pm Final Meeting: Wednesday, May 17, 7-8:30pm Team trainings: Students, only Sunday, 12:30-3:30pm February 19 April 9 May 7 _____ Yes _____ Not all of them – Please share why:
I understand that, if I am unable to attend the specified important dates, this may affect my consideration for mission teams.
Student Signature Parent Signature Road Staff Signature
Mission Journey Agreement
EXPECTATIONS FOR PARTICIPATION: Students & Parents/Legal Guardians must initial after each statement. Student
Parent/LG
Student
Parent/LG
Student
Parent/LG
I will attend all training sessions with the team prior to the journey. I understand and respect that approval must be obtained ahead of time in order to miss a meeting due to scheduling conflicts. I will maintain Christ-like character and behavior. I will handle any and all medical needs/immunizations prior to the journey. I will raise prayer and/or financial support. I will pay my balance due for my journey or, before the deadline to pay, meet with church staff to discuss a payment plan. I will commit to: praying before, during, and after the journey submitting to the authority of the leaders valuing unity of the team having a flexible, servant attitude
CANCELLATION PROCEDURE: I must submit a letter, in writing, to The Road stating the reason I no longer wish to participate in the journey. I must send a letter to supporters informing them of my decision to not go on the journey and advising them that support will go towards others on the journey. Expenses are incurred in advance for my participation in these journeys; therefore, for journeys in June, cancellation must occur before April 4 in order for me not to be assessed additional costs. For journeys in July, cancellation must occur before May 4 in order for me not to be assessed additional costs. If cancellation occurs after these dates, I must pay the difference between the cost of the journey and the amount of support raised.
JOURNEY GUIDELINES: For medical expenses incurred during the journey, receipts will be obtained and given to the parent(s) upon return. Reimbursement to Faithbridge must take place as quickly as possible. Filing claims with your insurance company is at your discretion and will not be done by Faithbridge and/or its staff. If my behavior is deemed unacceptable by Faithbridge’s staff or its journey leaders, I will be removed from the team or sent home at my parents’ expense. I agree to have my name (student’s) posted on the Faithbridge website from February 5 at 5pm until February 12 at 5pm for team placement decisions.
By signing this Agreement, I am indicating that I would like to participate in The Road Mission Journey, and I agree to all items contained in this Agreement.
Student’s Name
Student’s Signature
Date
By signing, I/we understand and agree to the items contained in this Agreement and agree to support our student fully in the mission journey process. Note: If possible; BOTH parents with legal guardianship rights should sign.
Parent or Guardian Name
Parent or Guardian Signature
Date
Parent or Guardian Name
Parent or Guardian Signature
Date
Parent Reference Form Student Name: We would appreciate your candid response to the following questions to assist us in knowing your student better. Along with the rest of the application, this helps us to evaluate and process where God might have him or her this summer. Parent(s) Name: 1. What are your thoughts about your child going on a Mission Journey? (hopes, fears, reservations, etc.) What do you hope your child gains/learns by going on a Mission Journey?
2. Where do you feel your child is in his/her relationship with God?
3. What strengths does your child have that would complement a team?
4. What 3 adjectives best describe your child? Explain, if necessary.
5. What do you notice when he/she interacts with new people?
6. When conflict arises, how does your child respond? (with peers and adults)
7. Where does your child thrive?
8. What else do we need to know about your child to best care for him/her (food allergies, medical history, special needs, disabilities)?
Over-the-Counter Medication Authorization Student’s Name: Current Age:
Date of Birth: Current Weight:
Allergies (food, latex, bug bites, etc.): My child is currently taking prescription medication(s).
______Y
______N
I permit my child to take/use the following over-thecounter medications (or their generic equal) according to manufacturer’s directions, should my student report a minor complaint to one of the journey’s leaders (i.e., headache, muscle pain, stomach ache, small cuts, blisters, sunburn, etc.). All medications are to be dispensed by an adult journey leader. Below is a list of the available over-the-counter medications.
ONLY initial the medications that your student is NOT permitted to take:
Tylenol Advil Head/Cold Congestion Relief Anti-Diarrheal Benadryl/Antihistamine Dramamine Aloe Vera Sunscreen Pepcid/Tums Cough Drops
Parent Signature Date Signed THIS AUTHORIZATION EXPIRES AUGUST 31, 2017
The Road | Faithbridge MISSION JOURNEY Medical Release & Waiver Student Name ________________________________________ Address ______________________________________________
M □
F □
DOB ____/____/______
City ____________________
Home Phone _______________________ Mom Cell __________________________
Zip_____________
Dad Cell _________________
Parent/Guardian Name _____________________________________ Email____________________________________ Person(s) to be contacted in emergency: ________________________________ Phone ______________________ Doctor’s Name __________________________________________________ Phone ______________________________ Insurance Company _______________________________________________
Policy/Group ID # _______________
Insurance Co. Phone ______________________________________ Medical Information (if any) that Adult Supervision should know: _____________________________________________
I, _____________________________________________, the parent/guardian of _____________________________, grant my permission for him/her to participate fully in one of the following events: □
LUBBOCK MISSION JOURNEY AND TRAINING
(hereafter referred to as “Activity”).
RELEASE: In consideration of participation in the Church Activity, I agree, on behalf of the above named child, his/her heirs and representative, to fully and forever release, Faithbridge Church, its staff, officers, elders and trustees, volunteers, host homes, agents and employees (hereinafter collectively referred to as “Church”) from any and all liability, claims, demands, damages, actions, or causes of action, whatsoever, belonging to my child or me arising out of or relating to the Activity, regardless of cause, even if such cause is the result of Church negligence. This release covers everything that happens from the time I leave my child at the Church until I pick him/her up at the Church or designated pick up location. CONSENT: To the best of my knowledge, the above-named child can fully participate in this Activity. I am aware of the risks and hazards connected with the Activity, and I hereby elect to allow my child to voluntarily participate in said Activity, knowing that the Activity may be hazardous to my child. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury that may be sustained by my child or any loss or damage to property owned by me or my child, as a result of my child being engaged in such Activity, regardless of who caused the damage. HOLD HARMLESS: It is my express intent that this release and hold-harmless agreement shall bind me, my heirs, assigns and personal representatives, the members of my family, spouse (if any), and that it shall be deemed as a release, waiver, discharge, and covenant-not-to-sue the Church. I hereby further agree to defend and indemnify the Church for any claim asserted or action brought against the Church arising out of or relating to my child’s participation in the Activity, including but not limited to the Church’s attorneys’ fees. I hereby further agree that this waiver of liability and hold-harmless agreement shall be construed in accordance with the laws of the State of Texas.
MEDICAL COSTS: I understand and agree that the Church will not be responsible for any medical costs associated with any injury my child may sustain. RULES AND REGULATIONS: My child and I further agree to become familiar with the rules and regulations of the Church concerning participant conduct and not to violate said rules of any directive or instruction made by the person or persons in charge of said Activity. INSURANCE: I hereby acknowledge that my child has adequate health and accident insurance to cover any personal injury to my child that may be sustained during the Activity. If you do not have adequate health insurance, you agree that you, personally, will be responsible for any medical expenses incurred. MEDICAL TREATMENT CONSENT: I hereby further authorize in advance, any necessary medical treatment required by the above named child while in attendance at this Activity. I hereby give permission to the medical personnel to order injection and/or anesthesia and/or surgery for my child as named above. I further agree to assume responsibility for the costs of any specialized evacuation and of any medical care and acknowledge that these costs are the financial responsibility of the undersigned. I also acknowledge that I have/will notify the Church’s staff of any special medical needs or information required by the above named child. INFORMED AGREEMENT: I have reviewed this Agreement and am aware of the risks involved in participating in the Activity and the possible injuries that may occur. I freely and voluntarily agree to allow my child to voluntarily participate in the Activity. In signing this Agreement, I represent that I understand this Agreement and sign voluntarily as an act of my own free will. The Church has not made any oral representations, statements or inducements, apart from this Agreement. I am at least eighteen (18) years of age and fully competent to execute this Agreement. Also, I understand that all rules and regulations for the Activity will be enforced and any violation by my child may result in a collect call to me with a possible request to come and pick up my child.
__________________________________________________ Signature of Parent/Guardian
__________________________ Date
KINGDOM COME MINISTRIES RELEASE OF LIABILITY AND MEDICAL CONSENT FORM Legal Name of Participant____________________________________________________ Phones: __________________________________________________________________ Participating Adult – (Home, Cell, Work)
__________________________________________________________________ Participating Minor Child’s Parent #’s – (Home, Cell, Work)
Home Address: ____________________________________________________________ Minor Child’s Parents: _______________________________________________________ Father
Mother:
Participant’s Insurance Co: ___________________________________________________ Group & Policy #’s: _________________________________________________________ Insurance Co. Phone Number: ________________________________________________ Important Medical Information (Allergies, Alerts):
I, the undersigned, being the Parent/Legal Guardian of the above participating minor child; do hereby give my permission for him/her to accompany the group and participate in the Activity or Activities listed below which are being sponsored by Kingdom Come Ministries (KCM): Activity: Summer Missions I certify that I am the Parent/Guardian of the participating minor child, am cognizant of the inherent dangers associated with travel and work in the inner city Lubbock, Texas. I am aware that certain aspects of the trip do indeed entail the element of risk including bodily injury, dismemberment or death. I understand and agree that NEITHER KCM, NOR ITS TRUSTEES, REPRESENTATIVES, INSTRUCTORS, EMPLOYEES, VOLUNTEERS, OR AGENTS MAY BE HELD LIABLE IN ANY WAY FOR ANY OCCURRENCE in connection with me/my minor child participating in the Activity which may result in the injury, harm or other damages to the participant, to me, and/or to my family. As part of the consideration for being allowed to enroll and participate in the Activity, I hereby personally assume all risks in connection with my/my minor child’s participation in the Activity. I FURTHER RELEASE KCM, ITS TRUSTEES, REPRESENTATIVES, INSTRUCTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS FROM ANY INJURY OR DAMAGE WHICH MAY BEFALL ME/MY MINOR CHILD WHILE I OR HE/SHE IS ENROLLED IN OR PARTICIPATING IN THE ACTIVITY. I FURTHER AGREE TO SAVE AND HOLD HARMLESS KCM, ITS TRUSTEES, REPRESENTATIVES, INSTRUCTORS, EMPLOYEES, VOLUNTEERS AND AGENTS FROM ANY CLAIM BY ME, OR MY FAMILY, STATE, HEIRS, OR ASSIGNS arising out of my/my minor child’s enrollment and participation in the Activity. I also authorize KCM to render or obtain such emergency medical care or treatment as may be necessary should any injury, harm or accident occur to me/my child while participating in the Activity.
I further state that I am of lawful age and am legally competent to sign this affirmation and release; that I understand the terms herein are contractual and not mere recital; and that I have signed this document of my own free act and volition. I further state and acknowledge that I have fully informed myself of the contents of this affirmation and release by reading it before I have signed it.
______________________________________________________ ________________________ Signature of Participating Adult Date
______________________________________________________ ________________________ Signature of Participating Minor Child’s Parent/Legal Guardian Date
THE ROAD 2017
Jan 22 / Sunday, 10am-4pm Application Day
Applications are due from 10am – 4pm in the Atrium of Center Court West **Parent and student must be present
Feb 5 - Feb 12 Teams Posted Online
Team lists are posted online at faithbridge.org/TheRoad Goes offline at 5pm on Feb. 12
Feb 12 / Sunday, 2pm Journey Orientation in Center Court West
Information for parents and students covering details including additional forms, meeting schedules, etc. You will also break out of CCW to meet your team and hear more about your mission opportunity! This will also be your last day to order Road Gear (online)! **Parent and student must attend
May 17 / Wednesday, 7pm Final Meeting in Center Court West
Final information for parents and students including final trip details, travel schedules, etc. **Parent and student must attend
May 21 / Sunday, all worship services Missions Sendoff
Mission teams will be commissioned at one of the regular Faithbridge services, 9am or 11am (Klein), or 10am (The Woodlands) Last day to pick up Road Gear! **Students attend, and family and friends are welcome!
September 10 / Sunday, 5pm Missions Celebration in Center Court West
Celebrating all that God did through our journeys - friends, family, everyone!
Mandatory Training Meetings February 19, Sunday 12:30-3:30pm April 9, Sunday 12:30-3:30pm, Center Court East May 7, Sunday 12:30-3:30pm, Center Court East
**Students must attend
Gear Shop Need some outfitting for your journey? Here’s what’s available in the Gear Shop this season! *Any Gear profits help support other Road participants by going to our scholarship fund.
*each journey participant will receive a t-shirt included in their journey cost
(includes cinch sack, flashlight, notebook, pen, and decal!)
ORDER ONLINE and check out pictures at Faithbridge.org/RoadGear OR on the Road Phone App by Sunday, February 12th to ensure your gear for this journey season!
PICKUP: Head to the Road Gear Shop to pick up your items on any of the following dates. Sundays from 9am – 1pm April 23 and 30; May 7, 14, and 21 Wednesday from 6 – 8:30pm May 17
